The Benefits Of Hot And Cold Therapy & Other Longevity Hacks

Coming up on this episode of the Doctor's Pharmacy.

This is basically these longevity switches in the body. And if we learn how to activate them in the right way or turn them off in the right way, we can really extend life.

Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me helping patients heal using real food and functional medicine as your framework for getting to the root cause.

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Hey, everybody, it's Dr. Mark Hyman. Welcome to a new series on the doctor's pharmacy called Masterclass, where we dive deep into popular health topics, including inflammation, autoimmune diseases, brain health, sleep, and lots more. And today, my friend and podcast host Drew Proett and I are doing something super fun. We're going to be answering community questions that you guys have submitted through a new video app called HiHo. You can follow me on HiHo and submit your questions there and you might see them on this podcast.

All right, Mark, great to be here. We got a bunch of great questions. The first one is from Mia on the HiHo app and she has a question that's right in alignment with everything you've been researching these days and that's the topic of longevity, senescence, and specifically hot and cold therapy. Let's key up this video for Mia.

Hi Mark, I'm just wondering if the best way to do cryo and heat therapy is to do cold first, then.

Sauna, or vice versa.

Thanks in advance.

Bye.

Listen, Drew, I am so excited about this question because I literally just handed in my book, Young Forever, about longevity, and I went deep into the science of hormesis, which is this idea that little stress that we give to our bodies creates a response that makes us healthier and stronger. And cold and hot are two hormetic therapies. Too much cold, you get hypothermia and die. Too much heat, you get heat stroke and die. So, it's that Goldilocks version of what do you want? And, the question was essentially, should you do cold first or heat first? And, I don't really think we have the science to really answer that question, but for me personally, I don't want to get in the cold first. I'd rather get in the hot first and then go in the cold. And then you can go back and forth and back and forth. And what's really amazing about these therapies is that they're accessible to most people. If you have a bathtub, which most people do, you can do these therapies. If you have a shower, you can do these therapies. So the best way to do it is if you can get access to a sauna or a steam. And I personally had a steam installed in my shower. You can get sauna blankets now. They're not that expensive. If you get yourself really hot, you can do a hot bath if you have a bathtub. So any kind of heat therapy will raise your body temperature. And what that does is two major things. One is it elevates something called heat shock proteins. And what are heat shock proteins? These are compounds that your body makes when you're overheated. And it's something your body makes, for example, when you have a fever when you're trying to fight infection. So two things happen. One is you increase the activity of your innate immune system. This is the ancient immune system that you have that's not antibody related, like COVID, you know, COVID antibodies and all that. vaccine. It's a very specific response to a specific infection. But an innate immune system is just a generalized response that fights infection and activates your immune system. So it's really important. Second is it actually creates these heat shock proteins, which help to repair and fix damaged proteins. So just to give you a little background, Drew and everybody, your proteins have to be not just strings of amino acids, but they're three-dimensional structures. that have to look a certain way, a certain shape to bind a lock and a key into a receptor. As we go through life and get various insults and stresses and poor diet and toxins and so forth, those proteins get funky and damaged. These heat shock proteins help to refold the proteins into their original form and allows them to bind better to receptors or it helps to clean up and repair the whole system. You get two things. One, you get the activation of your immune system in a good way. and two, you deal with one of the key hallmarks of aging, which is protein damage. And protein damage is what—when your proteins get damaged, they don't work very well. And most of our biology is run by proteins. And this is kind of mind-blowing, but maybe people know this or maybe they don't, but what is your DNA? Your DNA basically is code that tells your body how to string together different amino acids to make proteins. And the proteins are the messengers and information molecules, the immune molecules, neurotransmitters—these are all the important compounds that regulate almost everything in your body. Peptides are all little proteins. So that's what they do. And their proteins have to be a certain shape and a certain sequence of amino acids and they get damaged as we age. So as a longevity strategy, heating up your body is super awesome. That's why the Finnish live longer. And they did an amazing study in Finland where it's kind of funny. They basically tried to see how saunas were affecting your health and longevity. And the control group was people only had a sauna once a week because pretty much they do it all the time there. And if you did it like up to four or five, six times a week, you had a dramatic extension in your life. That was compared to the control, which was just once a week. So who knows if you don't do any, you might even be better than that. So getting heat is really important. And I, I find it really important. Whether it's a hot bath, whether it's a sauna or a steam. I got lucky yesterday. I went to a friend who built the Russian banya, and we went really hot in there. It gets really hot. And, you know, it just kind of.

Heats up and it just helped my body feel.

All kinds of amazing.

When you say really hot, Mark, like.

What was the temperature inside of there? I think it was like 180.

I think it was like really hot. Like it's like a, if you look at a lot of these finished studies.

And you look at the temperature that they're hitting, they're hitting 175.

Right?

Yeah, for sure. And then they go in the cold and they jump, you know, they have the cold plunge. So then the cold plunge does something quite different. The cold plunge does two major things. One, it activates your brown fat. this is your mitochondrial superpower where basically between your shoulder blades and your back, there's a special kind of fat called brown fat. It's metabolically active fat. You activate this brown fat and it increases your metabolism. It's really interesting because I can't do it, but guys like Wim Hof and other people learn how to activate the brown fat to heat up their bodies in the face of extreme cold temperatures. This was originally a Tibetan practice where they would take these Tibetan monks and they had a practice called drying of the sheets. and this practice called tumo. They literally wrap these young monks after they learn this practice in sheets dipped in ice water. They wrap them in the sheets in the middle of the Himalayas in the wintertime, and they have to dry the sheets. When they could finally dry the sheets, they would send them up, basically, in their underwear, up into the snow overnight. Basically, they didn't die because they learned how to activate those brown fats. Cold therapy really helps activate this brown fat, speed up your metabolism. The other thing it does is really amazing. It's like I hate to say it, but it's like cocaine for me. It activates dopamine, which is what cocaine does. It creates a sustained release of dopamine, which is what we're all trying to get more of for pleasure, focus, attention, feeling good, alert, and just able to really do stuff. It's really quite amazing. It's like taking a snort of cocaine when you go in an ice bath. You come out, you're like, Whoa, I feel alert. I feel focused. I feel energetic. I can do anything. I love going back and forth, and I go hot and cold, hot and cold. To me, I mean, when I had chronic fatigue syndrome, it was the only thing that really helped me have moments of actually feeling okay was through this hot and cold therapy. I'm kind of addicted to it. I do it wherever I go in the world. I try to find it. I was in Turkey recently. I went to one of the hammams. I always am trying to figure out, I did the polar plunge in Antarctica. I went for the head of sauna on the boat, the polar plunge. It's kind of amazing. The cold plungers are quite awesome. I was just in I was just in Idaho and I went in and it's really, really hot hot springs and then jumped in the icy river. And so, the more you can do that and you can't, not everybody can do the things I do, but if you can do it even in your cold shower in the morning, like one to two minutes in a cold shower, fill up a hot bath with hot water as hot as you can stand it. It'll go back and forth hot and cold. I go over in my steam and I felt my bath with really cold water and I just go back and forth. I have a friend who's got like a, he bought like at the hardware store like a trough they use for like feeding cows and horses water. And, he basically is an ice maker. He got all his ice in there, poison water, and you go with ice cubes all around you. So, there's lots of creative ways to.

Do it that don't cost a lot of money. Awesome. I love it. So, a bunch of clarifying questions, Mark, before we go to the next question.

Yeah.

So, first thing, I think you're on.

Record saying it's like cocaine, but obviously everybody knows if we're not— no, no, no. I don't snort cocaine. I'm not a fan of cocaine. I'm just saying we're all trying to activate dopamine, right? Think about the things that activate dopamine. Heroin, cocaine, smoking, caffeine—all the things that used to kind of prop us up. But this is a natural way that you can enhance dopamine. What's amazing about it is that it has a sustained effect. It's not just one shot and you get a snort and then you're in a crash. It really helps us sustain the dopamine and the norepinephrine in a way that actually helps you stay focused and alert. No, I'm not saying that you should go down and start cocaine. By the way, the other Another thing that activates it, and I got to do this the other night, it was super fun, I didn't tell you about this yet, but I'm an older dude, and I grew up in the era of the Grateful Dead, and I got to go to one of the Dead and Company shows recently in Boulder, and a friend of mine is the manager, and he gave us these free tickets. And I had another friend with me, and basically you go out and you give tickets to people who are trying to get in who don't have tickets. There's a lot of people go to these Dead shows, and they're desperate to get in, but they don't have money or they couldn't get a ticket. And there's a song called Waiting for a Miracle. And it's, you know, and everybody has these signs, I'm waiting for a miracle. And so you go out and you give these tickets to people and it's like a miracle. I might post one of the pictures where this, the amount of joy and the amount of pleasure you get from actually giving and altruism because we're all wired to help each other. We're all wired as social creatures. Because think about a human being out in the forest by themselves, they're kind of screwed, right? hard tribal people. We have to help each other. We have to work together. And so there's, we're hardwired for altruism and altruism also activates dopamine in the brain. So there's lots of ways to activate.

It, but I like giving things away and cold therapy.

Yeah.

And the best part about that compared to, you know, drugs are out there. And by the way, it's really interesting. I've heard a lot of anecdotal stories of people using in conjunction with maybe AA or treatment centers that they're going to how a lot of these processes actually help them get over their Addictions. Again, I'm sure some people are out there studying it, like they're studying it with psilocybin and smoking cessation. We had Dr. Roland Griffiths on the podcast before, but it'll be exciting to see people starting to use hot therapy.

Cold therapy to actually treat addiction. So, a couple other clari-- Wait, wait, wait. I want to add one more thing. Yes, please, please. The one thing I forgot to say, which is something I've written about for the last 30 years that activates dopamine is sugar. So, I don't know why I forgot it, but when you go for that cookie or that pint of ice cream, or whatever it is, that is activating the same receptors that we're talking about through the dopamine receptors in the brain and the nucleus accumbens. And so that's why people literally get addicted to sugar. But I'm more addicted to cold therapy and giving and service and that's how I get high, basically.

So you mentioned a few things that I think are worth breaking down. So we talked about the Finnish studies and the high temperatures that are there, you know, 170, 175, 180 potentially. And generally the time length inside of those, and again, if somebody's new to hot therapy. Obviously, first of all, saunas can be, you know, it's expensive to have a sauna in your house, but you can find saunas at local like gyms and other places and, you know, you can borrow from your friend, right? Use them. But a lot of people ask, and there's some great companies that are out there that, you know, we've known throughout the years, but they ask, what about infrared sauna? It can't get that hot, you know, are there still the benefits that are there even if the body of literature may not support the heat that they're getting to. Thoughts on that?

Yeah, I think there is literature on infrared saunas too, and it penetrates a little deeper. You can stay in it longer, and the temperature doesn't get hot, but it does heat you up quite a bit. I think either work. There are a number of things I didn't actually mention about heat, which is that it also increases the health of your cardiovascular system. It helps with weight loss. It increases the release of toxins from your skin through your sweat. It increases heart rate variability, which is one of the best metrics of your autonomic nervous system, your health of your stress response. A lot of us are overstressed and we have really poor heart rate variability. I wear an oral ring and I can track my heart rate variability and I can see what makes it good or bad. It's amazing to see how correlated it was your stress response. The higher your heart rate variability, the more complex your heart rhythm is, the healthier you are. People, for example, that have heart failure go into these saunas and they actually improve their heart failure just by increasing the health of their autonomic nervous system. It's really quite powerful. Okay, great.

That's a good option because for a lot of people, like you mentioned earlier, sauna blankets and there's a bunch of great brands that are out there, those can be an entryway that's a little bit more affordable. But like you said, you could even do a bath. If somebody was going to do a bath, and they were going to hop in. How long are we talking about staying in? Just like a general rule of thumb, if people are going to use their bath and a warm bath, how long.

Are we talking about staying in there? Well, I've been about this for years. One of my favorite things to do is I do an Epsom salt bath with lavender drops. Lavender lowers cortisol. That's why they put it in baby bath, Johnson & Johnson actually has done the research on this and it lowers the stress response. And Epsom salt has magnesium, which relaxes your muscles and nervous system, helps you sleep. the sulfur in Epsom salts, magnesium sulfate helps you detoxify. So it's really great. And I heat the water up as hot as I can stand it. So everybody's got a different tolerance for heat, but it's like where you have to get in, you kind of have to get in slowly because it's kind of too hot and you can barely stand it. That's kind of good. And you might be able to say five minutes, maybe say 15 minutes. So you stay until you kind of get really hot and then you can go right into bed and as your body cools down, you'll fall right asleep. So it's a great tool for sleep. It's a great tool for muscle relaxation. It's a great tool for detoxification. It's a great tool for doing things like heat shock proteins. And, you know, it's quite amazing. I just reminded me of this data that I saw in this sort of anecdotal stuff that I've heard of case reports of autism. So, autism is a disease of the brain that actually is about inflammation. And a lot of the inflammation causes a lot of malfunction in the brain through these deep form proteins and other things in the immune system. And it's been observed that when kids who have autism have high fevers, that they wake up from autism and then when the fever goes back, they go back to being autistic. So, it's really fascinating to see how heat plays a role in so many of the functions of our body.

We're just really beginning to understand this. So, Mark, one more follow-up question. You know, right now, you're recording the podcast out of San Francisco. It's great that we have modern technology that allows us to record anywhere, so this is awesome. So, for instance, because you travel a lot, what are one of the ways, for example, now, how you're looking to incorporate hot and cold therapy in because it's become part of your routine. So on a practical level, is it that you just have a lot of friends that are so into this too that you stay at their house and you just get to borrow their sauna? Any tips for people when they're on traveling?

I mean, yeah, I mean, listen, if you're booking a hotel room, try to get one with a bathtub. And I mean, most hotel rooms, hopefully, will have a shower. So you've got a hot tub and you've got a cold shower. It's pretty easy or you can fill the bathtub with cold water. or you can get ice cubes from the shower. So there's a lot of ways to do it. I really make a point of seeking this out. And I really have learned how to sort of hack my travel life so that I can stay healthy and then I can stay rested and I can keep rejuvenating myself. So yeah, I have friends who have this and I'm lucky because I'll tell my friends about it and then they'll get it and that's sort of kind of fun. But it doesn't have to be super fancy. You can just have a shower and a bathtub and that really is the and the easy way to do it for most people.

And a couple more clarifying questions. So how does this fit in your day with your normal routine and also when it comes to exercising and your movement that you have in your life? Is this something that you typically like to do before that or after that? So when does hot and cold therapy come in and how does that play a role in timeline again with exercise? So let's say I'm in my routine at home and I've written about this.

In my new book, Young Forever, what's Dr. Hyman's daily longevity routine? I mean, I just saw a guy who kind of was a fan. He had seen me in person. We were actually in the sauna together in the Russian banya yesterday. And he's like, Man, you look better than you did five years ago. Another person said, you look better than you did 10 years ago. I'm like, yeah, because I'm figuring all this stuff out. And so, I actually have a routine in the morning where I'll wake up and meditate 20 minutes. I mean, usually work out. And I travel with these bands and I had back surgery a couple of years ago and I learned really how to rehabilitate through Tom Brady's training program. I don't get any money for it. associate with it anyway, but it's the tb12 sports program. And, and I use these basically bands, and I bring them with me. I travel everywhere, and, and all I need is the bands on the floor, basically, and sometimes something to hook it onto, like a doorknob, you know, hotel room or a post somewhere to do some of the exercises. And, and so I do a workout for 30 minutes, and that's kind of a standard thing I can do anywhere I and then I like, if I'm home, I like to do seam. I have a steam shower. So I put the steam on while I'm working out. I'll go into steam super hot, like 10 minutes, and then I'll fill up a bath just with ice cold water, and I go back and forth maybe a couple of times. And, and then afterwards I have a protein shake, and I'll usually use my Pegan Shake protein powder. I think we're discontinuing that. And I'll use goat whey. And the reason I use goat whey is because goats are one of their, they're regenerative, the way that the ones that I find are regeneratively raised. And two, they have because all the whey has some casein in it. It can be inflammatory. I use whey because it has A2 casein. Then I add the whey and then I put all my other goodies in it, which I talked about in the book, my longevity kind of package of stuff. That's my kind of routine. Then I just feel amazing for the day. I don't have any problems with energy and I really can focus. It's just a great way to start the day and I can probably get all that done in about an hour. The meditation sort of adds probably 20 minutes. maybe hour, hour and a half, but it's really an amazing way to start the day.

And then I get to do what I do. And I'm sure you have a truncated version that you do on days where you don't have that full hour, because there's probably people that are listening today that are like, Whoa, an hour, I'm lucky if I get 20 minutes that's there. Of course, a big part of your message is always that you feel so good, so it's not like a chore for you to do this. You actually are looking forward to doing it. But give us the truncated version. When you have 20 minutes and there's a super busy day, and you're in launch mode or whatever, you got to catch like four or five flights. What is kind of your absolute one or two things that is crucial for.

You in the day? Well, I mean, I think, you know, even if I can just get like 20 minutes of my workout in, not a full half hour, or I do two sets instead of three sets like I did today, because I had a lot going on. So I did two sets and then I'm ready for my podcast. And sometimes I have time for hot and cold, and then I don't, and I just don't do it on those days. I always make sure that I take quality time and the meditation thing is super portable. I do a kind of meditation that's like a version of a Vedic mantra meditation. You don't need to be in a quiet room and I can do it on an airplane, I can do it in the back of an Uber, I can do it anywhere. I can just go in and I just kind of, the world disappears and I disappear on where I go, but it's like taking a three-hour nap. For me, these are productivity tools. If I work out and if I do this meditation, I have so much more focus and more energy that whatever I'm doing, I do way better and more focused. Instead of taking me twice as long, it takes me half as long and I do a better job. In some ways, it seems like it's taking time, but actually it's saving time in the end.

Hey, everyone. It's Dr. Mark. You probably heard me talk about how much I love information. infrared saunas? Well, they've been linked to so many different benefits, like better muscle recovery, calming of the nervous system, improved circulation, and even activation of the immune system to support protection and healing. Now, saunas also promote the release of feel-good endorphins that gives you that blissed out feeling and gives your skin a healthy glow. I think it's fascinating that so many cultures around the world have some kind of history of sauna use, but I don't think it's a mistake. People have recognized for centuries that heat exposure and sweating have therapeutic effects. And now it's easier than ever to take advantage of that ancient wisdom on a regular basis. I know not everyone has the room on their budget to have their own sauna at home. So I was really excited to learn about the infrared sauna blanket from a higher dose. It gives you all the benefits of infrared saunas in an easy to use portable blanket at a much lower cost than a standalone sauna. This blanket is really cool. It has a layer of amethyst to deepen the infrared benefits, a tourmaline layer to generate negative ions, and a layer of clay to to balance heat in a charcoal layer to bind pollutants as you detox. If you don't have the budget or space for a full-size sauna, this is an amazing and less expensive option to uplevel your wellness routine. Right now, get your own infrared sauna blanket or infrared PMF mat@higherdose.com today and use my exclusive promo code PHARMACY15 at checkout to save 15% off. That's higherdose.com and the code is PHARMACY15. That's F-A-R-M-A-C-Y-15 or just go to higherdose.com/hymen to get your 15% off today. Now, let's get back to this week's episode of the Doctor's Pharmacy.

So, Mark, before we get back to these video questions, I actually have a question for you that maybe I'm not super clear on, even though we're business partners and close friends. Working out now is such a core part of your life. And I know you like the word movement, right? That's a big part of your approach. It's kind of a movement mindset. What happened a few years ago that shifted for you where it was kind of like, A nice thing, you were active, you'd play tennis every so often, you might do some hiking to like it switched and it was like, whoa, this is foundational to my life and it's kind of like I'm not going to sacrifice it in my day. What was that switch that took place? Yeah, I mean, listen, I've always exercised.

To be a runner. I did yoga. I was a yoga teacher. I bike, I played tennis. So I always stayed very active. But, you know, in my mind, I had this rationale that, oh, if I do yoga and I ride my bike or I play tennis, like I'm good. And I always told people they should lift weights, but I just hated the gym. It was smelly, it's stinky, I didn't like it. And I don't, it hurt when I did weights. I couldn't do 10 push-ups when I was 50 years old. I was like, this hurts every time. I don't like it.

It's the truth. What kind of pain?

Just curious. What kind of pain? No, I can do 10 push-ups. Your chest hurts for days. Like I could do 10 push-ups. My chest hurts. All this muscle pain, you know, from lifting weights, I would try and I'm like, sore for days. I'm like, this is stupid. I'm not doing this. So, I mean, even though I know in my head, it was like, I knew I should do it. And then I'm like, you know, then I, then I turned 60 and I'm like, all right, all right. I'm, I'm like, I gotta get smart here, cause I tell everybody to do it and I can't be a hypocrite and I have to do it. So I started to, I joined a gym and I got a trainer and I started doing a little bit. But then, then I had a back problem again. After 20, 30 years, I had another back thing and I had surgery. in 2020. And then I couldn't move. I couldn't walk. I was in pain all the time. It was pretty miserable. And I'm like, look, this is bad. And I, and I, and I have a limp. I had a limp for 20 years, and my body was all out of kilter. And so it was just getting worse and worse. I'm like, how can I live to be 120 if I can't walk? So I basically had the surgery, took my time to sort of heal from the surgery, and then I went to the Tom Brady training program. And I, you know, it was such a revelation for me because I was able to start really slow. the bands, you know, they don't injure your joints. You can do them anywhere. It's not like I have to take an hour, drive to the gym, you know, get going. It's like a whole takes hours of my day. I just don't have that kind of time. So, like, literally, I got back from where I was doing today. I, you know, had some food ordered, jumped down and, you know, was down here in my. And then where I'm staying, I just put my underwear on. I didn't have, you know, workout shorts, and I didn't need shoes or anything. I just like. grabbed my bands and I did a quick workout. So, but it really became foundational when I realized that, that I, if I wanted to stay strong and out of pain, I had to do this. So I, I really doubled down on it and I will do it minimum three times a week, sometimes four or five. So, so I really am committed to it and I think it would be everywhere. And, in fact, I forgot it. Their friend's house the other day because we were all working out and I was eating a workout of five people and we had it in this spot and I left and I forgot it and I was like in a panic and I go, hey, you got it FedEx to me like right away. I need it tomorrow morning. I got it and I have it here and I did my workout. So it really becomes routine and you can take it anywhere. You can do it almost anywhere. And I mean, I even show you, I got the bands right here. So if you want, I can go show you. It's pretty easy.

Well, no, I mean, you got me hooked on it and now I do a training session with their virtual coaches on a at least two to three times a week. And it's been, it's a fantastic thing. Again, we have no affiliation with them. They have a free app that's there, you know, so that people can do those workouts. You can go on YouTube, type in tb12 and, you know, there's a bunch of them that are there. So, so one clarifying question on that. You mentioned that, you know, you used to do 10 push-ups before and, like.

Your chest would hurt. Do you think you, the way I do 70 now with no, no, right in a row, I can do, like, I can do like three sets of 25 with the bands around my back. So like it's unbelievable. I'm way stronger now at 62 than I was at 40 or 50. All right, well we're gonna fact check you.

Maybe on one of our next podcasts we are gonna do push-ups together.

Okay, all right, all right, all right. But seriously, Drew, I'm not bragging Drew, but like I work out my friends, like I had this, I work out with a 30 year old and then they're 40 year old and like the guy was 50 and like None of them could do what I did. I was using the heavier bands and they were all like, oh, and I was like, come on guys. That's when you've built up to it, it really works.

I've seen you over the years. We've worked out a few times together too. It's very inspiring. So the question that I had was this, is it that you've just been doing a different training routine or also has how you've changed your diet specifically, I have a question about sort of prioritizing protein. Has that also helped you in your ability to build up more strength during your workouts. So that's the question that I had for you.

Yeah. So again, this is a really controversial topic, which is protein. Where do you get your protein? How much protein? When do you eat your protein? It's complicated. And there's movies like Game Changers that come out which make people think that, oh, you can be vegan and just be this huge, strong bodybuilder and just eat vegetables. and I think there's a subtext to that. These guys are pound, and I've talked to them, they're pounding highly processed vegan protein powders, or they're eating jacked up protein powders that are supplemented with amino acids. And you can't overcome biology. I mean, the science is so clear. So there was a group of scientists that got together that are protein experts, and they wrote a review paper of all the literature It's called PROTAG, P-R-O-T-A-G-E study. They basically came up with the conclusion that particularly as we age, we need more high quality protein, and we need it regularly throughout the day, and we need it to contain certain amino acids in the right amounts. One of the problems with plant proteins is that it's very low in a key amino acid called leucine and other branched chain amino acids. Leucine is a rate limiting amino acid when it comes to making more muscle. In other words, it's like if you have a factory and you have an assembly line and you're missing this one key step, like if you like making a car but you don't have tires, you just can't make the car. And leucine is like that. If you don't have leucine, you can't kick in the biochemical machinery to synthesize new muscle. So either you have to eat massive amounts of plant protein, for example, you have to eat three cups of rice to equal four ounces of chicken. Now, who's going to eat three cups of rice? It's a lot of rice or a bunch of two or three cups of beans. And then you get 1,000 or 1,300 calories as opposed to 200 calories. Now, I'm not saying it's bad to eat grains and beans. I'm just saying it's very tough to get what you need. If you look at what happens to a lot of beans, as they get older, they get skinny and they have low muscle mass and their hormones change. and they get more insulin resistant. There are ways around it. If you're vegan and you're committed to being vegan, I'm not against it, but you have to be smart. For example, you have to use extra branched-chain amino acid supplements, or you can take, for example, additional amino acids through something that I use in my practice that's been studied a lot in research in Europe. It's called amino acid complex, which is a combination of amino acids that's designed to increase muscle synthesis and combat what we call sarcopenia, which means low muscle mass. So for me and what the NYL also said was you need to eat the right amount of protein within an hour of working out in order to actually activate the muscle synthesis. And you need to eat it with the right amino acids. And you need about 20, depending on your size and build. So obviously if you're Shaquille O'Neal and seven feet tall, you might need a lot more. And if you're five foot zero and 100 pounds, you might need less, but it's about 25 five grams to 30 grams of protein, which is usually about the size of your palm. So, the best way to think about it for the average person is the size of your palm of protein. And, I say this when I say protein, I mean, if you want to build muscle, you have to eat muscle, basically. And, you can kind of cheat by either combining animal protein, like less animal protein with plant protein, or by eating jacked up plant proteins where you add in these amino acids. so there's a lot of ways around it, but you can't argue with biology and with science. And it's just so clear. If you don't believe me, if you're, you know, think I'm making this all up, just go ahead and look up that Pro- Age study. I've written a lot about it in my new book, Young Forever, which is coming out February 23. And I've used it on myself. And I'm like, holy cow. Like, I look at pictures of myself when I was 40, and I'm like, you know, I was biking, you know, 30 miles and I was doing yoga and I was doing all this stuff and my body just looks like I'm like it just it looks like then I was 60 and now I'm like 25. So I don't know what's going on but it worked. What I'm telling works and it's and when I use with my patients it really works and that's really the science that I've adapted to myself and it's really changed my biology and my cognitive function, my energy and I really, really lowered more dramatically even the starch and sugar. because I, you know, look, like I, when I started doing nutrition back in the 90s and being a doctor in functional medicine, that was the era where still we're telling you do a lot of carbohydrates and even, you know, healthy carbohydrates like grains and beans. But for some people, it's tough. And if you're, you know, one of the, you know, the people who are metabolically unhealthy, which is almost nine out of 10 Americans, then you're not going to tolerate the amount of starch and sugar that you could, for example, if you were more lean and fit and robust. I can get away with eating stuff sometimes that if, for example, my diabetic patients can't because they're not metabolically flexible. I train myself to become more metabolically flexible. I can actually have more metabolic degrees of freedom, we call it. I'm not saying you should always eat junk, but I'm just saying I can get away with having a dessert once in a while or having some coconut ice cream or something, like, I'm not worried about it. But I think for the most part, it's really about lowering dramatically the starch and sugar, increasing the fat, and actually keeping not excess of protein, but keeping the right amount of protein. And the other thing, Drew, is a lot of people, oh, the government says we should have about 0.8 grams per kilo of protein. That's a gram, a kilo is about 2.2 pounds. that's the minimum amount to prevent protein deficiency disease. It's not the optimal amount for health. It's like when you say, how much vitamin C is the minimum, the recommended amount? It's like 60 milligrams. Or how much is the vitamin D amount that's recommended to prevent deficiency? It's like 30 units, which prevents rickets. Well, okay, you're not going to get rickets, but what's the optimal amount of vitamin D you need operate all your biological systems well? Well, it might be 2,000 or 4,000 or 5,000 or 10,000. So, I think this is where we get all confused in nutrition because the government recommendations are designed around deficiency diseases, not for optimal health.

So, one last follow-up on that question and thank you for that breakdown on the protein. I think some people who are paying attention to the space of longevity, which a lot of different people are talking.

About, oh, God, okay, well, there is.

The question of like, okay, well, we we need enough protein to avoid sarcopenia. And then some people are saying, whether it's IGF-1 or other stuff, that excess protein could hinder longevity. And then you have people like Peter Attia, who kind of has a philosophy that you do, which is that if we look at a lot of these large observational studies that are being used to say that excess protein can harm our longevity, they're looking at people who are not really consuming a lot of vegetables in their diet. And on top of that, they have high, you know, they have poor metabolic health as well, too. So is it the metabolic health or is it the high protein? So we'd love to get your take on the situation since we're all- I.

Mean, it's super complicated, right? Because a lot of people who look at the data on protein and aging go, wow, you know, protein activates something called mTOR. And I mean, I don't want to get into that now, Drew, but I literally, I'm so deep in it because I just finished my book. So, I'll sort of explain what the science is about. So, this is basically these longevity switches in the body. And they're really powerful. And if we learn how to activate them in the right way or turn them off in the right way, the ones that need to be turned off, we can really extend life. So, for example, calorie restriction is one of the few things that's been shown to dramatically extend life. If you cut your calories by a third, you extend your life by a third. And that for a human means living to 120. Now, personally, I don't want to do that because I like to eat and it's not fun and you're going to be grumpy and hungry and you're going to have other downside effects from it. I met this guy who was part of the calorie restriction society. He's like, what do you have for breakfast? I have five pounds of celery. And I'm like, okay, no thanks. Right.

And if he's also eating five pounds of celery, is he more likely to fall from and have a hip fracture and end up dying at the age of 80 because he doesn't have enough muscle mass.

Exactly. Exactly. So the main thing that people are talking about protein is this thing called mTOR. Now, that's one of the longevity switches, but there's four of them. Two of them are detecting excess and are turned on by an abundance or excess of compounds like amino acids and carbohydrates. so that's the mTOR pathway and that's the insulin pathway. Now we need both of them, right? It's like you need mTOR to be turned on because otherwise you can't build muscle and synthesize protein, right? But if it's turned on all the time and it's by the way turned on by not just protein but also by sugar, okay? Then you're just going to create like, you know, it's like a tumor that grows out of hand. You don't get this chance to repair the body. so think about your kitchen. If you just threw dishes in the sink and you never cleaned up and you kept putting garbage in the garbage can and you just never clean up, well then your kitchen is going to be a mess and you're going to be doing anything. That's basically with the body is you need time to both cook dinner and then clean up. That's what the body does. An mTOR, when it's turned on, actually synthesizes protein, which is not a bad thing. It's a good thing. like muscle. But if it's turned on all the time, you can't activate this really essential process that we now know is so critical to longevity that we activate during starvation or calorie restriction, which is something called autophagy, which essentially means self cannibalism. Auto means self and phagy means to eat, like a, you know, macrophages or some, a white blood cell that eats bad things and so you want to eat yourself up, essentially, it's recycling. So you need both the construction crew and you need the recycling crew. And it's got to be in the right balance. So yes, we need to shut off mTOR or silence mTOR or lower mTOR, but not all the time. And so that's why we talk about, you know, having a 12 to 14 to 16 hour window between dinner and breakfast. That's really important. And you can kind of decide when you want to do that. But you gotta be sure you don't eat three hours before bed, whatever you do. It's not gonna work if you say you start eating at six o'clock at night and then eat till midnight and go to bed at midnight. That's a bad idea. So you wanna make sure you give yourself three hours before bed. But if you give yourself these periods of temporary starvation, like a 12-hour fast, 14-16, it really activates this self-cleaning process. It's like a self-cleaning oven, right? And our bodies can do that. and you can also do it by doing a deeper clean, like a 24 or 36 hour fast once a week, or a three to seven day fast once a quarter. So there's a lot of ways to do it, or the fasting mimicking diet, which is Valter Longo's work, which does the same thing. It's an 800 calorie diet for five days, and you can do that once a month or once a quarter. So there's a lot of ways to hack the system. Ketogenic diets do the same thing, but the idea is you want to give your body a period of rest. so the people who say, well, don't eat protein, it's going to activate mTOR and mTOR activated is going to kill you and make you live shorter. It just doesn't take into account the whole picture. And so you have to look at all the data. Even the main study that people quote about this shows that if you're younger and you eat protein, it may not be good, but a lot of protein. But if you're older, if you don't, it's really bad. So even the people who are like saying that we should be restricting protein, as you get older, there really is no debate that we need protein. In fact, as you get older, you need way more protein. Why? Because there's something called anabolic resistance. Anabolic resistance means like, you know, anabolic hormones and what steroids people take to kind of build up the bodybuilders. Anabolic means to build up, right? There's an anabolics. It's like yin and yang. It's like, you know, the sun and the moon. It's like day and night. There's this balance in the universe. And we have the anabolic, which is build up, and we have a catabolic, which is to break down and clean up. So, if you're always in anabolic state, that's bad. But anabolic resistance happens as you get older where your body is harder to make protein muscle. So, you actually have to eat more protein as you get older. That doesn't mean you have to be eating 24-ounce ribeye steaks every day. It just means you need to actually understand what your body's doing and measure it and pay attention to what happens to your body. Are you gaining muscle? Are you losing muscle? You can tell by looking in the mirror. or you can do these body composition tests and look at your muscle mass and your body fat mass and so forth. So, science is so interesting about this, but it's like everything in the universe, there's a balance. And so, it's not like we always want to shut off mTOR. And there may be hacks, like I talked about in my book, this thing called rapamycin, which is essentially a compound that's really cool, Drew. They found on Rapa Nui, which is Easter Island, where they had this these statues that they don't know how they got there. And it's like, maybe it's aliens. Who the hell knows? But basically they found this compound in the background of the statues that they started studying and they found, oh, maybe it's in any fungal they call rapamycin, like erythromycin. But then it didn't really work that well. Then they found it helps to modulate immune function. So it's used in, in transplant medicine. But they also found it actually silences mTOR. In fact, mTOR means the mammalian target of rapamycin. So actually, they named this particular pathway after rapamycin. And when you take rapamycin, it kind of silences mTOR. So now there's a lot of people who are in the longevity space taking it. I don't recommend it yet. They're actually studying, for example, rapalogs, which are things that mimic rapamycin without some of the side effects because it can have side effects. So I think you're going to be kind of smart about this, but the whole longevity research is fascinating. So they're kind think of it as a starvation in a pill, where you mimic starvation without actually starving. I kind of like that.

I think one central point that you made that's really important for anybody who's following along with the subject is that even something like exercise, that increases mTOR, but just acutely and nobody says that exercise is bad, so to all of a sudden say that eating a higher protein diet to make sure that you don't have muscle mass loss, especially as you age, but even when you're younger, and you mentioned vegans. I used to be a vegan back in the day. I'm not a vegan now, but even still people who are not vegan and eat all sorts of different food, they can also be under eating on protein because they have a lot of refined carbohydrates and other things inside of their diet and they're just not tactical about making sure that they get enough protein and of course the importance of strength training. So it's all a lot of layers to it, but it feels like through discussion and more people talking about it, we can all get a chance to benefit from the industry and experts understanding how to better convey the messaging inside of the right context for the public to follow.

Maybe we can have a debate with Peter Tia and David Sinclair and Chris Kresser and Valter Longo. I'm going to have a conversation about this, because I think it'll be so fascinating.

Yeah, yeah, yeah. There's a lot of really great people. And there are you know, just to.

By the way, they're all my friends and I respect them all and I've learned a lot from all of them. It's just everybody's got Lilica, it's like.

The blind men in the elephant looking at a different piece of it. Totally, totally.

And we should never assume that we're.

Not, I mean, not me, I'm just an interviewer. You're the actual blind man. I'm one of the blind men too. I'm one of the blind men too. Yeah, we should never estimate that. We should never underestimate our ability to be also in that camp as well. But, you know, just for anybody who is vegan, just a little shout out that I want to make a mention of. There are people inside of the vegan community that are talking about the importance of making sure that vegans especially get protein and have high quality protein recipes. You know, Mark, I come from the Hindu background and that's like the Vedic tradition, the Hindu tradition. A lot of those people, the Jain tradition, they sort of spiritually believe that, you know, we shouldn't be eating animals. And obviously, you know, that's a tradition.

They eat a lot of dairy too, right?

And they eat a lot of dairy and, you know, that sort of thing. So they don't believe in eating animal meat, but there's still an importance in prioritizing protein. So one gentleman, Simon Hill, he's a nutritionist, and I believe it has a PhD in nutrition. He is a vegan plant-based who talks a lot about, you know, high protein recipes. And I'm sure there's some many things that he disagrees with you on or me on, but he is telling people to prioritize protein. So there is even a divide in the camp. It's not like all of a sudden, all vegans think that don't eat protein. There are people that are looking at the literature and saying, no, actually we have to prioritize protein, especially as we age.

And by the way, I do have a lot of patients that are vegetarian or vegan, they're Buddhist. I don't think you have to eat meat to be healthy, but I do say, look, here's how you adjust your amino acids through supplements or through various.

Protein powders to compensate. And it makes a huge difference. It does, it does. so, you know, since we're on this train Mark, and, you know, we've only taken one question here, but I feel like we're on a roll. So let's keep on going here, right?

I'm gonna.

I'm gonna just take you on. I know, you know, when we have to record these podcasts together, people are like, what are you gonna talk about? I'm like, look, anytime I can get Mark talking about his favorite subjects, these things will fly by, and it'll be a lot easier to record. And this is actually what most people are interested in right now. So last week on the topic of things that people take for longevity, last week, Metformin was in the news for a few different, you know, reasons. Can you talk a little bit about that? And again, whether or not this changes your perspective when we're talking about potentially prescription drugs that people are leaning on in the biohacking space to maybe help with longevity or maybe not help with longevity.

Yeah, fair enough. So, listen, I'm not against medication just out of the gate, not at I think there are compounds. These are compounds we use. I joke, I say I'm a medicine man. I'll use whatever works, whether it's an herb or whether it's medication. It's just how it's used. When it's used, why it's used, is it the right medicine for the right problem, the right dose at the right time? It's really important to understand the mechanisms, how they work, what the risks are, what the side effects are. I think with metformin, we're going to learn a lot more. There's a large trial going on called the TAME trial, which is targeting aging with metformin. And it's a very big, you know, government funded, rigorous trial where we're going to get better answers. My view on metformin is, I would say, I'm on the fence. Just to be honest, I'm on the fence. I was a hard no, and now I'm on the fence. And I really looked deeply into the literature as I was researching my book. I'm like, okay, put all my biases aside, all my judgments aside against it. The thing that concerns me is that there are so, and when I was researching my book, and just being a doctor doing this for decades, there are so many ways to do the same thing that metformin does without some of the risks or the problems. The things that actually are not medications may work better. Like rapamycin, for example, it's tough to replicate that through lifestyle. Yes, you can eat 30% less food, but you're going to be hungry and cranky and miserable and feel a lot longer even though you live longer, right? But with Metformin, there was a large trial a number of years ago called the Diabetes Prevention Trial, the DPP. And this is a very well-respected trial. It's been replicated on those following data. And this trial basically looked at pre-diabetics, about 10,000 people, and then gave them lifestyle changes, and I'll explain that in a minute. Metformin or nothing. And the lifestyle changes far outperformed metformin. Far outperformed metformin. So, you know, I think the metformin reduced the progression to diabetes by 31%. The lifestyle reduced the progression to diabetes by 58%. Now, I actually had a woman who worked with me on one of my books as it sort of helping edit it, and she was in the diabetes prevention trial set who told me exactly what did you do? Well, we had a low fat diet. We had group support. We had supervised exercise, and we had to account for everything we did. I'm like, oh, okay. Yes, you ate a healthier diet. It was not processed junk food, but it was a low fat diet. It was a higher carbohydrate diet. Two, you had group support. Three, you had accountability. Four, you had supervised exercise. that collecting, we all know that all those things can make a difference. Getting off junk food helps. But it turns out that high carbohydrate diets are not the best diets for diabetics. In fact, they're the worst diets for diabetics. And David Ludwig's work has really demonstrated this, the work of Sarah Hallberg, a friend of mine who recently died of breast cancer, God bless her. She was done tremendous research using some of the Virta health data on ketogenic diets and diabetics, fully reversing type 2 diabetes. not managing diabetes, but fully reversing it in 60% of patients. And so we know that even in the diabetes prevention trial, the diet was far from optimized. And even that was far better than metformin, like almost twice as good as metformin in preventing diabetes. So then I say to myself, well, if that's true, why lean on the drug when we know we can activate the same longevity pathways? as metformin. Now, what metformin does is it works on, remember I mentioned these longevity switches? So, two of them are detecting excess insulin, it detects excess glucose and sugars and carbohydrates, mTOR, excess protein, and also sugar. And then there are sirtuins and also the AMPK. And I'll explain in a minute because it's a little complicated. This is the hardest part of the book and my editors give me a hard time because It's like, it's really important science, but it's kind of geeky, and I try to simplify it. Basically, the way I describe it is there's four longevity switches: mTOR, and the insulin ones, which respond to excess of calories and carbohydrates, sugars, proteins. Then, there's the ones that detect scarcity. There's sirtuins and the one called AMPK. AMPK stands for AMP, adenosine monophosphate kinase. Now, that sounds like a big mumbo jumbo full of words, but essentially your body makes energy called ATP. It's what happens when you eat and you breathe. You make the gasoline that runs everything in your body through the mitochondria, the powerhouse of yourself. Instead of gasoline, your body produces ATP. When it's used up, you're giving two phosphorus molecules away as part of the way you release energy. The phosphorus is like the sparklers on July 4th. That's like that bright energy. You're basically using that to kind of run and power your body. So when you use up two of the phosphorus molecules, it goes from ATP, which is triphosphate to monophosphate, that's AMP. And so basically the body says, oh, shoot, there's not enough energy around. I better do something. And so then activates all these amazing compensation processes, these sort of adaptations to starvation, which is a good thing. And that actually turns off inflammation, it gets your mitochondria making new mitochondria, it activates sirtuins to activate DNA repair, it shuts off mTOR to increase autophagy, and so like there's all this cool stuff that happens that basically makes you younger and heals your body. So it's all these innate healing mechanisms we have. It's so cool because all these innate healing mechanisms allow us to repair, heal, and live longer and not die if we don't have enough food. Okay? So metformin is an AMPK activator, and that's good. And that's how it lowers blood sugar, makes you more insulin sensitive, it's a diabetes drug. And it seems to be that people who take these drugs seem to live longer, have less death. It's kind of interesting. So I kind of think there's a promise to it. But, there's some downsides to it. It can cause GI distress. It can maybe affect the mitochondria in a bad way. So, I'm kind of on the fence. I personally want to be healthy and vibrant and want to be 120 or 180, but I'm not taking that drug yet. I know a lot of people are in the space like David Sinclair and others, and I respect what they're doing and they're amazing scientists. I just know the power of lifestyle, and I know the power of lifestyle to activate these pathways. And what's even more interesting, and it's a whole other podcast we can get into some time, is the plant compounds that we have co-evolved with also regulate these pathways. So there are all these cool things that we can eat or herbs we can use. And Drew, I just got back from Korea, which is one of the blue zones. And Dan Buettner hooked me up with somebody there, and we, he's the guy who wrote the blue zones book, a really amazing friend and great, great guy who's really discovered a lot of Longevity Secrets of these blue zones for people who are very old. They, for example, were eating all these wild foods, like wild greens. And every day they drank this special tea that's made from wild herbs. And there's wild herbs everywhere. One of them's wild sage. And I was like, I, and actually, one morning I went to go milk goats with this goat guy, this goat shepherd. And, and, he's like, come on, sit down. So we had, he showed me how to make the goat cheese and we made the goat cheese. It was kind of fun. and then after he's like, let's have some tea and, you know, talk. And, of course, he's, he's a Greek. I didn't speak Greek, but they had a translator there, and, and we had this amazing, wild sage tea. And I'm like, wow, this is really amazing. So I, I'm like, looked up what it was. I looked up the scientific name, and I studied what was in it. And it's full of all these things called epigallocatechin, epigallocatechins, which is these powerful compounds in green tea, but there was no caffeine. And these are long, again, these, these green tea extracts, these compounds are also in wild sage, activate a lot of these longevity switches. So there's all these plant compounds we can use that are part of food and other things that I think are way better than taking them inform. So that's my opinion now. It might change when the tame trial comes out if the benefits are so great. So I'm not against it. I'm just kind of waiting.

Yeah. And I think that, you know, I didn't dig into the science of what came up last week, but I think it was in the news specifically for potentially interfering with muscle growth inside of the body?

Do you know if that was true? Yeah, so mitochondria, that's the thing. So that's the thing. It's got a dark side. All drugs have a dark side, right? So, for example, rapamycin turns off mTOR, but also may cause all kinds of other problems like immune suppression and other things you don't want. So, it's like you got to be careful with these compounds and you got to know how to use them. And, personally, I like the idea of using these phytochemicals. and there's this concept called phytohormesis, which people are talking about, which is like the hot and cold we talked about earlier in the podcast. These plants are like toxins. They're the plants defense mechanisms. But a little dose of them also activates our biology to repair and heal. It's kind of mind-blowing and I don't want to get too kind of woo-woo about it, but actually when you understand how how does these molecules know to bind to these receptors in our body? It's just mind-blowing. I think we co-evolve with these plants and our bodies are kind of lazy and we don't make vitamin C because we can get it from food. Well, we don't make a lot of these compounds because we can get it from these plants that we grew co-evolve with. I think this whole science of food is medicine is just beginning. What's really exciting is the Rockefeller Foundation, I think, is spending $200 million partnering with other groups to create the periodic table phytochemicals. There's 25,000. There's probably a lot more that we haven't even discovered. You know, it's like just a kind of a treasure trove of medicines that are out there that we now can use as part of our diet or as teas or as herbs and spices or as supplements to actually help us live a long time and be healthy.

Well, that's great, Mark. I think that's a lot of fantastic information for today's episode. You know, we only took one question, but that question got us rolling on a topic that you're just super passionate about. which is longevity. So thank you for the breakdown. And I'm going to pass it over to you to go ahead and conclude.

Us out for today's episode. Well, Drew, I feel bad because I literally could talk forever and I don't want to lose people. And I hope you guys actually understood half of what I said. And if you don't, I promise it's all going to be my new book, so you should definitely wait. It's coming out February 2023. And I'm not trying to sell new books, which, which, but I just really want to get this information out there. I really want people to understand how to activate their body's own innate healing mechanisms and and that's really all we have time for in today's masterclass. So if you really liked it, I want you to submit your questions for next time on hiHo and maybe I'll answer them in the next upcoming masterclass. And if you enjoyed this podcast, please share with your friends and family. I bet they'll get a lot out of it. Subscribe wherever you get your podcast. Leave a comment. How have you used hot and cold therapy? How have you experimented with some of these things? And what has it done for you? So I'd love to hear from you and we'll see you next next time on the Doctor's Pharmacy. Hey everybody, it's Dr. Hyman.

Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter and in it I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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